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Background and Aim of the Study: Surgical results after aortic valve repair in patients with aortic regurgitation (AR) of tricuspid valve morphology and with no evidence of aortic root disease have not yet been clarified., Methods: Between January 1994 and June 2001, aortic valve repair was performed in 40 patients (eight females, 32 males; mean age 61.0 +/- 10.5 years) of this type. Surgical results and follow up data were summarized after aortic valve repair (for AR) in these patients., Results: One patient died in hospital (mortality 2.5%). The mean cardiopulmonary bypass time was 143.5 +/- 47.4 min, and mean aortic cross-clamp time 99.8 +/- 34.3 min. At follow up, the mean AR grade was 1.5 +/- 0.8 and mean NYHA class 1.0 +/- 0; both parameters showed significant improvement compared to preoperative status (p < 0.0001). Survival was 94.9% at one year and 82.6% at five years. The five-year reoperation-free rate was 87%., Conclusion: Aortic valve repair for AR in patients with tricuspid valve morphology is a safe procedure that provides good intermediate-term results.

Background and Aim of the Study: Evaluation of leaflet dysfunction in aortic valve repair is important. In eccentric aortic regurgitation (AR), it is unclear whether leaflet dysfunction other than prolapse exists. The study aim was to validate the hypothesis that eccentric AR correlates with leaflet dysfunction., Methods: Both anyplane 2-D images produced by a 3-D reconstruction system and surgical views for 21 patients with eccentric AR (11 with aortic valve prolapse, group A; 10 without prolapse, group B) were analyzed prospectively. Vertical height from annulus to coaptation point (termed AC), and distance from coaptation point to sinotubular junction (CS) were measured at early diastole., Results: For group A, AC and CS values were 1.3 +/- 2.2 mm and 25.9 +/- 3.4 mm respectively for leaflets of eccentric AR jet origin, and 3.8 +/- 0.4 mm and 22.7 +/- 2.1 mm for other leaflets. For group B, AC and CS values were 4.7 +/- 0.9 mm and 39.8 +/- 7.0 mm for leaflets of eccentric AR jet origin, and 7.8 +/- 0.9 mm and 31.9 +/- 5.7 mm for other leaflets. The AC for leaflets of eccentric AR jet origin was smaller than AC for other leaflets (p < 0.01) between both groups. There was no difference between CS for leaflets of eccentric AR jet origin and other leaflets in group A, but CS for leaflets of eccentric AR jet origin was larger than for other leaflets in group B (p <0.01). AC and CS values for leaflets of eccentric AR jet origin in group B were larger than those for group A. Leaflets of eccentric AR jet origin were always shifted toward the direction of the base in the anyplane images, and elongated in the surgical view., Conclusion: Anyplane 2-D images obtained by 3-D echocardiography showed that aortic leaflets of eccentric AR jet origin shifted towards the direction of the base with or without prolapse, and were accompanied by dysfunction. Color flow Doppler determination of the eccentricity of AR jet origin was useful in predicting aortic valve dysfunction.

Aim: Repair of the bicuspid aortic valve is not generally considered the treatment of choice. Our success with this procedure leads us to report our immediate and mid-term, Methods: From August 1993 to December 2000, 19 patients with aortic regurgitation due to congenital aortic valve underwent aortic valve repair (17 men and 2 women with a mean age of 42+/-17 years; range, 16 to 70 years). The mean preoperative aortic regurgitation grade was 3.1+/-0.8 on a scale of 1 to 4. Mean preoperative New York Heart Association functional class was 1.9+/-0.8. Fourteen patients had pure aortic regurgitation, 2 also had infectious endocarditis, 1 had angina pectoris, and 2 had an ascending aortic aneurysm., Results: There was 1 hospital death (5.2%), and 1 patient required re-operation due to recurrent infectious endocarditis. Mean aortic regurgitation grade at discharge was 1.1+/-0.9, and functional class was 1.1+/-0.2. All patients were followed for a mean duration of 40+/-23 months (range, 0.5 to 84 months). There was 1 late death, and two patients required aortic valve replacement. The 5-year survival rate was 90+/-7%. The 1- and 5-year re-operation-free rates were 87+/-12% and 76+/-23%., Conclusions: Bicuspid aortic valve repair is a safe procedure with good early postoperative, Results: However midterm results are not satisfactory. Re-operation is a promising alternative and progress aortic regurgitation were complications. Bicuspid aortic valve repair to valve replacement that requires additional study to individualize treatment.

Recently many cardiovascular operations have been performed with minimally invasive cardiac surgery (MICS). It is reported that MICS is superior to standard full sternotomy in regard to cosmetic and post-operative recovery. In our institution, aortic valve repair operations have been performed to aortic valve insufficiency. This time, we performed aortic valve repair by minimal access "J" sternotomy. A 63-year-old male with degenerative aortic regurgitation underwent aortic valve repair by MICS. He had experienced dyspnea on exertion 7 days before admission. Preoperative transthoracic echocardiogram showed the grade of aortic regurgitation (AR) was severe. Surgery was successful and the grade of AR became trivial. This combined procedure have merits for patients because of freedom from anticoagulation and small incision. Such combined surgery may be indicated in the treatment in a subset of patients with degenerative AR.

Osteogenesis imperfecta is a disease in which fragile bones readily cause fracture. Valvular disease concurrently develops. However, the surgery-related mortality rate is approximately 30%. In this study, we report 2 patients with osteogenesis imperfecta who underwent valvular heart surgery. Patient 1 was a 31-year-old male. He had previously been diagnosed as having osteogenesis imperfecta. Echocardiography suggested aortic valve insufficiency, and aortic valve replacement was performed. Patient 2 was a 59-year-old male. During admission, osteogenesis imperfecta was diagnosed. Echocardiography suggested mitral valve insufficiency, and mitral valve plasty was performed. In the 2 patients, intraoperative hemorrhage was marked. However, there were no fatal complications. We also reviewed the literature.

Objective: We studied immediate and mid-term results after aortic valve repair., Methods: Immediate and mid-term results were studied in 63 patients undergoing aortic valve repair, calculating survival and reoperation free rates., Results: Subjects were 49 men and 14 women aged 15 to 76 years (mean: 53 +/- 17 years). Mean preoperative aortic regurgitation grading of 1 to 4 was 3.2 +/- 0.7. Mean preoperative New York Heart Association functional class was 1.9 +/- 0.8. Two in-hospital deaths occurred. (3.2%) Mean aortic regurgitation grade at discharge was 1.3 +/- 0.8 (p < 0.0001; vs preoperative grade) and functional class was 1.1 +/- 0.2 (p < 0.0001; vs preoperative class),--significantly improved. Overall follow-up was 98.4%, and mean follow-up continued 41.4 +/- 22.1 months. Mean functional class at follow-up was 1.2 +/- 0.4 (n = 49), improved from preoperative class (p < 0.0001). Mean aortic regurgitation grading at follow-up was 1.8 +/- 0.8 (n = 41), improved from preoperative grading (p < 0.0001). Five-year survival was 95.1 +/- 2.8%. One-year reoperation freedom was 96.6 +/- 2.4% and 5-year 77.9 +/- 6.9%., Conclusions: Survival after surgery was good, while reoperation was comparable to other reports but less satisfactory compared to reoperation freedom after aortic valve replacement. Based on reoperative findings, a change in indication was made. We believe technical refinements could improve postoperative results.

We developed a new technique of aortic root repair which may be able to eliminate the potential problem of leaflet damage, resulting from the direct contact of the aortic leaflets with synthetic vascular grafts during systole. This report describes our technique of annuloaortic repair and the operative results. Between February 1995 and October 1998, 13 patients underwent annuloaortic repair. The patients included 8 males and 5 females (mean age 50 years). Four patients had grade IV/IV aortic regurgitation (AR), 5 had III/IV AR, 2 had II/IV AR, and 1 had no AR preoperatively. Regarding the preoperative functional status, 1 patient was classified as New York Heart Association class IV, 5 were class III, 6 class II, and 1 class I. Concomitant cardiovascular procedures were performed in 12 cases. Aortic valvuloplasty or annuloplasty was performed in 7 patients. Both operative and short-term postoperative results with pre- and postoperative echocardiographic findings were studied retrospectively. The mean total cardiopulmonary bypass time was 212 min. The mean aortic cross-clamp time was 130 min. Circulatory arrest was induced in 5 patients. Postoperatively, 7 patients had no AR. Three patients had grade I/IV AR and 3 had grade II/IV AR. Perioperative changes in aortic annulus, mid-sinus portion, and sinotubular junction diameters were determined echocardiographically in 5 patients. The preoperative diameters were 2.7 +/- 0.4, 5.4 +/- 0.5, and 4.7 +/- 1.0 cm, respectively. The postoperative diameters were 2.3 +/- 0.5, 4.2 +/- 0.5, and 3.5 +/- 0.5cm, respectively. Ten patients were class I and 2 were class II. This technique of annuloaortic repair with or without aortic valvuloplasty is applicable to a certain subset of patients with aortic root disease and AR. Both the indications for this procedure and the long-term results should be confirmed.

A 61-year-old male with degenerative aortic valve regurgitation, mitral valve regurgitation and chronic atrial fibrillation underwent a combined reparative procedure consisting of aortic valve repair, mitral valve repair and maze procedure. Surgery was successful and postoperatively the patient is in NYHA class I, without anticoagulation. To the best of our knowledge, this is the first clinical report of this combined reparative surgery. As advances are made in valve repair surgery, it is expected that similar combined procedures will be performed more frequently in future. The benefits of avoiding valve replacement and anticoagulation after such combination treatment is discussed.

Background and Aims of the Study: The aortic regurgitant jet is frequently eccentric, and Doppler color flow mapping techniques of the distal jet is influenced by this eccentricity. The aim of the present study was to determine whether the effective regurgitant orifice area (EROA), determined by the proximal isovelocity surface area (PISA) method using multiplane transesophageal echocardiography (m-TEE), could be used to evaluate the severity of aortic regurgitation (AR) in patients with an eccentric jet., Methods: Forty-eight patients with eccentric AR were studied. Values of EROA determined by the PISA method were compared with results from cross-sectional area (CSA), vena contracta (VC) width, aortic angiography, and regurgitant fraction., Results: Values of EROA correlated well with results from CSA (r = 0.73, p < 0.001), VC (r = 0.74, p < 0.001), angiographic grade (rs = 0.90 p < 0.001), and regurgitant fraction (r = 0.84, p < 0.001) in patients with eccentric aortic regurgitation. Values of EROA > 0.27 cm2 were always associated with a regurgitant fraction > 0.4, while EROA values < 0.27 cm2 were always associated with a regurgitant fraction < 0.4., Conclusions: We conclude that, in patients with an eccentric jet, measurement of EROA values by the PISA method using m-TEE is a reliable method of assessing the severity of AR.

An occluder which intermittently became stuck in the open position with concomitant aortic regurgitation was encountered in a patient subjected to an aortic valve replacement with a 23 Omniscience prosthetic valve. The patient was intermittently aware of the complete momentary disappearances of the valve sounds, the etiology of which could not be discerned. During fluoroscopic examination, the occluder became stuck for a few cardiac cycles in what appeared to be the fully open position before finally moving. Prosthetic valve malfunction was thus diagnosed. The emergency operation was successful. Operative findings revealed that a thin thrombus had developed in a curtain-like fashion on the left ventricular face of the prosthesis with mild tissue overgrowth along the perimeter of the valve. The Omniscience prosthesis was replaced with a 19-mm St. Jude Medical prosthesis, and the patient's postoperative course has been uneventful.